Outcomes and health-related quality of life after esophagectomy for high-grade dysplasia and intramucosal cancer

Hypothesis: The reported morbidity and mortality associated with esophagectomy for high-grade dysplasia (HGD) and intramucosal cancer (IMC) have led asymptomatic patients to consider less invasive and possibly less effective treatments. This study provides a critical assessment of outcomes and health-related quality of life (HRQL) after esophagectomy for HGD and IMC. Design: Cohort analytic study. Setting: Section of thoracic surgery at a tertiary referral center. Patients: All patients who presented between May 1991 and February 2003 with a biopsy-proven diagnosis of Barrett esophagus with HGD or IMC were assessed. Main Outcome Measures: Prospective analysis of postoperative morbidity, mortality, HRQL, and gastrointestinal symptoms. Results: Follow-up was complete in 36 patients. Mean follow-up was 4.9 years (range, 0.5-12.0 years). The incidence of postoperative invasive cancer was 39%, with stages ranging from I to IIB. There were 4 major complications (11%) and no operative mortality. Twenty-eight patients were alive, with a cancer-free survival of 85%. The HRQL outcomes (Medical Outcomes Study 36-Item Short-Form Health Survey) were comparable with those of age-and sex-matched controls. Significant differences in post-esophagectomy gastrointestinal symptoms were seen with a decreased incidence of heartburn (P <=.001) and increased requirement for a slower speed of eating. Twenty-two (79%) of the 28 patients described their current eating pattern as normal or insignificantly impacted. Conclusions: Esophagectomy for HGD and IMC can be accomplished with low morbidity and mortality. Furthermore, most patients are able to resume a normal eating pattern, and postoperative HRQL can be equivalent to that of the general population.